Information Architecture and Technologies that

Support Health Care Information Systems

Chapter 8

Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Learning ObjectivesGain a basic understanding of the core technologies

behind health care information systems: System software Data management Networks and data communications Information processing distribution schemes Internet, intranets, and extranets Clinical and managerial decision support

Discuss emerging trends in information technology (such as mobility, Web services, Internet, wireless).

Identify some of the major issues in the adoption of information technologies in health care organizations.

Discuss why it is important for a health care organization to adopt an overall information systems architecture.

Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Why IT/IS: Error Rates • World-class competitiveness in

Manufacturing < 230 errors per million opportunities

• Financial services < 5 errors per million• Healthcare: 6000 –300,000 errors per million

–Healthcare errors are likely under reported• malpractice threats• practitioner confidentiality

concerns

Error rates in healthcare are orders of magnitude higher than in other

industries

OutlineCore Technologies

System Software Data management and access Networks and data communications Information processing distribution schemes Internet, intranets, and extranets Clinical and managerial decision support Trends in user interactions with systems

System Architecture

System SoftwareA series of programs that carry out basic computing functions Manage user interface, files and

memory Operates peripherals Allows development of applications

without have to include basic computer instructions

System SoftwareOperating Sytems (Personal Systems)

Proprietary Windows Mac OS

Open source Linux

Production SystemsMVSUNIX

System SoftwareInterface Engine—a software program designed to simplify the creation of management of interfaces between applications systems (Altis, 2004)

Data Management and Access

Relational Databases Relational Database Management

System (RDMS) Applications have three layers Interface Data manipulation Tables

Data Management and Access

Object-oriented Database Object-oriented database

management system (OODBMS) Object-Relational Database

management system (ORDBMS)

Data Management and Access

Data dictionaries—document data definitions

Clinical data repositories—large databases that include data from a variety of sources

Data Management and Access

Data Warehouse and Data Mart

Non-relational structure to facilitate “drill down” retrieval

Data mining—discovering patterns in data

Networks and Data Communications

Network Communication protocolsNetwork Types and ConfigurationsNetwork Media and BandwidthsNetwork Communication Devices

Network Communication protocols

Needed for communication among networked computers an devices

Open Standards Interconnection (OSI) Seven Layers Conceptual model, not a set of actual

specifications

Network Communication protocols

Internet Model—Transmission Control Protocol/Internet Protocol (TCP/IP) Layered model Represents a set of actual protocol

specifications at each layer

Network Communication protocols

Other protocols Ethernet—Local Area Networks Asynchronous Transfer Mode (ATM)—

fast transmission speeds Bluetooth—wireless devices IEEE 802.11 (Wi-Fi)—popular for

wireless computers

Network Types & Configurations

Local Area Network (LAN) vs. Wide Area Network (WAN) LAN—devices are under the control of

one organization in the same geographic area

WAN—an network that extends beyond a LAN

Network Types & Configurations

Topology Physical or Logical Example of Ethernet is a Physical “Star” and

Logical “Bus”

Network MediaCommon Types

Twisted pair wire (Category 5 most common)

Coaxial cable (older) Fiber optic cable Microwave Spread spectrum

Network MediaCommunications across WAN require a service carrier POTS Leased line Integrated services digital network

(ISDN) Purchased T-1 (or other) line

Network BandwidthBandwidth = Capacity of the transmission med1a

Greater capacity = greater speed

Rates expressed as bits per second (bps)

Network Communication Devices

Hub—device in which data from the network come together

Bridge—connects neworks at the data link layer; networks with the same protocols

Router—operates at the network layer; help determine the destination of data

Network Communication Devices

Gateway—connects networks with different protocols; operates at or above the transport level

Switch—may be a gateway or a router; all switches rout data to their destinations

Distribution SchemesTerminal to Host—dumb terminal interacts with host computer

File Server—application and database are on one computer; user’s computer gets data files from file server

Client/server—multiple servers with specialized functions; client runs application & server has data

InternetEvery computer or device has a unique Internet Protocol (IP) address

Use changed dramatically with the introduction of Hypertext Transfer Protocol (http) and the World Wide Web (www)

InternetWWW

Uniform Resource Locator (URL)

Example-- http://www.josseybass.com

Web Browser Plug-ins Mark up languages HTML XML

InternetOther Protocols

E-mail (smtp, pop3, imap)File Transfer (ftp) Internet telephoning (VoIP)

Intranets & ExtranetsIntranets

Secure computer network that uses Internet technologies, but is internal to an organization

Extranets Similar to intranets, but includes

business partners or the organization

Health Care Information Systems: A Practical Approach for Health Care Management 2nd Edition Wager ~ Lee ~ Glaser

Web 2.0Web 2.0 is a range of Web-based

communities, services, and technologies, including social-networking sites, wikis, blogs, and messaging capabilities.

The “2.0”reflects the view that this collection represents the second generation of Web technologies and capabilities.

Decision SupportDecision Support Systems (DSS)Artificial Intelligence

Decision SupportThree steps of Decision Making

Intelligence Design Choice

Problems are Structured Unstructured semistructured

Decision SupportTransaction based systems use for structured problems

DSS is needed for semi and un- structured problems

Decision Support System

Stand alone generally has three components Data Management Module—

database, data warehouse, clinical data repository

Model Management Module—user selects model to be applied to problem

Dialog Module—the user interface (Oz, 2004)

Artificial IntelligenceA branch of computer science that is devoted to emulating the human mind Example: Google Multiple types Expert systems Natural language processing Neural networks Fuzzy logic

User InteractionsInput DevicesOutput DevicesExternal Storage DevicesMobile Personal Computing Devices

Input DevicesStandard—mouse & keyboardOther

Trackball or trackpad Touch screens Source data input devices, such as

bar coding Document Imaging Speech Recognition

Output DevicesComputer MonitorPrinterSpeech

External Storage Devices

Sequential Magnetic tape

Direct Access Magnetic disks Floppy disks Zip drives RAID CDs & DVDs Optical tape Flash memory

Mobile Personal Computing

Personal Digital Assistants (PDAs)Pocket PCsLaptop computerTablet computerCellular phone combinations

Information System Architecture

The coming together of an information system is guided by the IS architecture

Consists of concepts, strategies, and principles

Platforms are specific vendors and technologies

Infrastructure generally refers to networks and network applications

Architecture Perspectives

Characteristics and Capabilities

Architecture ensures organizationally defined characteristics and capabilities

Application Integration Best of Breed Monolithic Visual integration

ArchitectureIt is important for health care organizations to have thoughtful architecture discussions

SummarySystem SoftwareData Management and AccessNetworks and Data Communications

Network Communication protocols Network Types & Configurations Network Media & Bandwidth Network Communication Devices

Summary (cont.)Distribution SchemesInternetIntranets & ExtranetsDecision Support

Decision Support System Artificial Intelligence

Summary (cont.)User Interactions

Input Devices Output Devices External Storage Devices Mobile Personal Computing

Information System Architecture